Medications and Psoriasis | Which Medications Are Used In Psoriasis

A Comprehensive Guide to Medications Used in Psoriasis Treatment

Introduction:

Psoriasis, a chronic autoimmune skin condition, requires a multidimensional approach to treatment. While lifestyle modifications and topical treatments play a vital role, medications often become necessary to manage moderate to severe cases of psoriasis. In this article, we provide a comprehensive guide to the medications commonly used in psoriasis treatment. From topical creams to systemic therapies, understanding the different medication options empowers individuals with psoriasis to make informed decisions in collaboration with their healthcare providers.

Topical Medications:

Topical medications are usually the first line of treatment for mild to moderate psoriasis. These medications are applied directly to the affected areas of the skin and can help reduce inflammation, itching, and scaling.

a. Topical Corticosteroids: Corticosteroids are the most commonly prescribed topical medications for psoriasis. They work by reducing inflammation and suppressing the immune system. These medications come in different strengths and formulations, and their usage should be monitored to avoid potential side effects.

b. Vitamin D Analogues: Vitamin D analogs, such as calcipotriene, regulate skin cell growth and differentiation, helping to reduce the excessive cell turnover seen in psoriasis. They are often combined with topical corticosteroids for enhanced efficacy.

c. Topical Retinoids: Retinoids, derived from vitamin A, can be used as a topical treatment for psoriasis. They help regulate skin cell growth and reduce inflammation. Topical retinoids are usually prescribed for localized areas and are not recommended for use on sensitive skin.

d. Calcineurin Inhibitors: Calcineurin inhibitors, like tacrolimus and pimecrolimus, are prescribed for psoriasis in sensitive areas, such as the face, groin, or underarms. They work by suppressing the immune system and reducing inflammation.

e. Coal Tar Preparations: Coal tar has been used for decades to treat psoriasis. It helps slow down excessive skin cell production and reduces inflammation. Coal tar preparations are available in various forms, including creams, ointments, and shampoos.

Phototherapy:

Phototherapy involves exposing the skin to ultraviolet (UV) light under controlled conditions. This treatment modality can be an effective option for individuals with moderate to severe psoriasis or those who have not responded well to topical treatments alone.

a. Narrowband UVB: Narrowband UVB therapy uses a specific wavelength of UVB light to slow down the excessive skin cell turnover and reduce inflammation. This treatment is usually performed in a clinic or doctor's office several times a week.

b. PUVA: PUVA combines the use of psoralen, a medication that sensitizes the skin to light, with UVA exposure. The psoralen can be applied topically or taken orally before the UVA session. PUVA treatment requires close monitoring due to potential side effects, including an increased risk of skin cancer.

c. Excimer Laser: Excimer laser therapy uses a focused beam of UVB light to target specific areas of psoriasis. This treatment is typically performed in a healthcare provider's office and may require multiple sessions.

Systemic Medications:

Systemic medications are prescribed for individuals with moderate to severe psoriasis or those who have not responded well to other treatments. These medications work internally, targeting the underlying immune system dysfunction responsible for psoriasis.

a. Methotrexate: Methotrexate is an oral medication that suppresses the immune system and reduces inflammation. It is commonly used for moderate to severe psoriasis and requires regular monitoring of liver function and blood counts due to potential side effects.

b. Acitretin: Acitretin is an oral retinoid medication that helps control the excessive growth of skin cells and reduces inflammation. It is often prescribed for severe psoriasis or when other treatments have not been effective. Acitretin is not recommended for women who are pregnant or planning to become pregnant due to potential birth defects.

c. Cyclosporine: Cyclosporine is an immunosuppressant medication that targets the immune system to control psoriasis symptoms. It is generally prescribed for short-term use due to potential side effects, including kidney problems and high blood pressure.

d. Biologic Therapies: Biologic therapies are a newer class of medications that specifically target molecules involved in the immune system's inflammatory response. These medications are administered by injection or intravenous infusion and are highly effective for moderate to severe psoriasis.

• Tumor Necrosis Factor (TNF) Inhibitors: TNF inhibitors, such as adalimumab, etanercept, and infliximab, block the action of TNF, a cytokine involved in inflammation. They are administered by injection or infusion and are effective in managing psoriasis symptoms.

• Interleukin (IL) Inhibitors: IL inhibitors, such as ustekinumab and secukinumab, target specific interleukins involved in the inflammatory response. These medications are administered by injection and have shown significant efficacy in treating psoriasis.

• Other Biologic Therapies: Several other biologic therapies targeting different pathways in the immune system are also available or under development for psoriasis treatment, including IL-17 inhibitors (e.g., ixekizumab, brodalumab) and IL-23 inhibitors (e.g., guselkumab, risankizumab).

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• Combination Therapies:

In some cases, healthcare providers may prescribe a combination of medications to achieve optimal control of psoriasis symptoms. For example, topical medications may be used in conjunction with phototherapy or systemic medications to enhance efficacy and minimize side effects.

Conclusion:

Psoriasis is a complex condition that often requires a combination of lifestyle modifications, topical treatments, and medications for effective management. The selection of medications depends on the severity of the condition, individual response, and potential side effects. It is essential to work closely with a healthcare provider to determine the most suitable treatment approach and to regularly monitor the effectiveness and safety of the chosen medications. With advancements in treatment options, individuals with psoriasis have a range of medications available to help control symptoms, improve quality of life, and achieve long-term remission.